Same-Day Surgery Manager

What keeps you up at night worrying?

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

I was posed with an interesting question from the editor of Same-Day Surgery a few days ago: "If you lie awake at night worrying about work, what is it that you worry about?"

A good question for anyone in health care, or any business really. For me the answer is finding qualified staff members to work in the operating room environment. We still have open positions across the country, and it is difficult to find experienced individuals. It stands to reason that the pool of qualified candidates for directors, administrators, PACU, and the OR are dwindling. There are many new surgery centers and hospitals being built or expanded each year, and there are just so many people to go around filling them.

I polled my clients to ask them the same question. I was a little surprised to find that the greatest issues that kept them awake at night were related to computers/information technology. The average department/center has one server and 10 workstations (desktop computers). Keeping them all up and running and keeping staff from instant messaging is an ongoing problem for many centers.

The other issue facing the respondents was similar to mine: finding qualified staff. We recently ran an ad for a surgery center administrator in Kansas City. The ad cost $456, and we received one reply. And that was from someone who thought it sounded like a "cool" job and asked, "Do I have to have a high school diploma to apply?" Since many professionals do not (apparently) look at newspaper ads anymore, you need to get a little more contemporary in your thinking. Surprisingly, we have reached a number of people on This web site has local classifieds for 450 cities worldwide. It is mostly free.

The last response that I received was just "physician relations," which can mean just about anything. Getting along with surgeons is an art form. My best advice is the following:

  • Recognize that like all of us, when physicians' needs have been met, they are usually docile and open to suggestions. Never confront them just after they case was canceled, the OR was not ready for them, or anesthesia is late. When they are hanging around in the lounge waiting for their late case to start is just not a good time to even look at them.
  • Every case they bring to your operating room has a piece of your paycheck attached to that patient. Enough said.
  • Don't download your problems to them. They have their own.
  • When a particular surgeon is a problem, pick one or two people that have a good relationship with that surgeon. Have that individual/individuals approach the surgeon about problems such as signing their charts or cost per case.
  • Anything you send them must be repeated three times before you get a response.
  • Get to know their office managers, and relate all your issues to them. They have the greatest control over their surgeons' schedules and moods.

[If you would like to be added to Earnhart's survey group, send your e-mail to Various surgery-related questions are sent periodically to the group for immediate feedback. Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 1000 Westbank Drive, Suite 5B, Austin, TX 78746. E-mail: Web:]